Lecture 19 - Pneumothorax And Pleural Effusion Flashcards
What is a pneumothorax?
Air in the chest that shouldn’t be there
What is the relative pressure in the pleural cavity?
Negative compared to atmosphere (essentially a vacuum)
What does a negative pressure mean
Pressure less then atmospheric pressure
What does a postive pressure mean?
Pressure greater than atmospheric pressure
Describe how the pressures change in the lung during inspiration and expiration:
Pressure in the lungs negative so air moves in until it becomes zero
Diaphragm relaxes making pressure in the lung negative forcing air out
What happens to the negative pressure in the pleural space with a pneumothorax?
Becomes closer to zero as air moves into it
How does air in the pleura affect the lung?
Reduces the pressure gradient and reduces the expansion of the lung
Why do you have pain on deep breathing with pneumothorax?
Can’t inflate lungs properly
What signs does a pneumothorax produce?
Reduced air on entry
Hyperresonant to percussion
Reduced chest expansion on affected side
What are the 4 types of pneumothorax?
Spontaneous (primary and secondary)
Iatrogenic
Simple
Tension
What is a spontaneous pneumothorax?
Pneumothorax occurring without obvious trauma iatrogenic cause
Primary
Secondary
What is considered a primary spontaneous pneumothorax?
No underlying lung disease
What is considered a secondary spontaneous pneumothorax?
With existing lung disease like COPD
What is an iatrogenic pneumothorax?
Caused by medical interventio n
What is a simple pneumothorax?
Where air iis going in and out so the volume of air in the pleura is not changing
What is a tension pneumothorax?
Air is going in but not coming out so the pneumothorax expands and gets bigger and bigger causing increased pressure on the mediastinal structures
What does SQITARS stand for?
Site
Quality
Intensity
Timing
Aggravating factors
Relieving factors
Symptoms (secondary)
Pain tool
What does a pneumothorax look like of CXR?
Look at image 1 on last slide
Lung fields/markinggs dont extend to the lung margins
What is the pneumonic used to remember how to study a CXR?
RIP ABCDE
Rotation
Inspiration
Penetration
Airway
Breathing
Cardiac
Dense structures
Everything else
What would be found on exam with a pneumothorax?
Hyper resonant on percussion
Reduced air entry
Reduced vocal fremitus
Reduced chest expansion on affectd side
How do you treat a pneumothorax?
Drain the air from the pleural space
Needle aspiration
Intercostal chest drain
Where do you insert a chest drain to drain a pneumothorax?
Triangle of safety
What are the borders of the triangle of saftey?
Pec major (lateral border)
Latissimus dorsi (lateral border)
5th intercostal space (mix axilalry line)
When inserting a chest drain do you insert it above or below the rib?
Above to avoid intercostal neurovascular bundle
